Qureos Mentor

Driscoll Children's Hospital

Driscoll Children's Hospital provides top-tier pediatric care in South Texas, emphasizing the importance of community and collaboration in healing. With a commitment to excellence, the hospital serves as a vital resource for families, ensuring access to specialized services and innovative healthcare solutions.

<div>
 
 
 Where compassion meets innovation and technology and our employees are family.
 
 
 
 
 
 Thank you for your interest in joining our team! Please review the job information below.
 
 
 
 
 General Purpose of Job:
 
 
 
 The staff nurse is a professional Registered Nurse (RN) who provides direct nursing care to an assigned patient population, service line or clinic department. The staff nurse, utilizing the nursing process, plans and delivers effective patient care within the Texas Nursing Practice Act scope of practice and within the framework of Driscoll Health System&rsquo;s vision and mission of excellence and integrated care delivery. The staff nurse practices within the established standards of practice, ethical guidelines, policies and guidelines reflective of the American Nurses Association (ANA) and their specialty service line. The staff nurse completes specific duties and maintains current competence in the skills and nursing practice according to the service line or area of primary work assignment.
 
 
 
 Essential functions and behavioral expectations:
 
 
 
 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
 
 
 Standards of Nursing Practice Assessment
 
 
 
 <ul>
 <li>
 Collects pertinent data through initial and ongoing focused assessments to analyze the patient&rsquo;s condition and follows through with appropriate reporting and actions. Conducts comprehensive assessments of patients' physical, psychosocial, and emotional needs
 </li>
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 Utilizes appropriate tools to gather relevant data to inform patient care decisions
 
 
 
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 </ul>
 
 Diagnosis/analysis
 
 
 
 <ul>
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 Analyzes assessment data to determine actual or potential diagnoses, problems, and issues
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 Verifies the diagnoses, problems, and issues with the healthcare consumer and interprofessional colleagues
 
 
 
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 </ul>
 
 Outcomes identification
 
 
 
 <ul>
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 Identifies expected outcomes for a plan individualized to the patient or situation
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 Collaborates with the patient/family to define outcomes integrating culture, values, and ethical considerations
 </li>
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 Works collaboratively with other healthcare team members which may include other RNs, Licensed Vocational Nurse (LVN), Advanced Practice Nurse Practitioners (NP), Physician Assistants (PA), Physicians and Medical/Nursing Assistants and administrative support staff to address patient needs promptly
 
 
 
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 </ul>
 
 Planning
 
 
 
 <ul>
 <li>
 Develops, prioritizes, implements, and modifies an individualized evidence-based plan of care in partnership with the person, family and healthcare team
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 Contributes to creating an environment that is patient focused, family centered and is designed to provide continuation of care and patient transition management
 </li>
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 Advocates for compassion, responsible, and appropriate use of interventions
 
 
 
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 </ul>
 
 Implementation
 
 
 
 <ul>
 <li>
 Administers medications and therapeutic treatments using appropriate devices per clinical guidelines and orders
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 Recognizes and intervenes to address abnormal responses to medication therapy and initiates corrective therapy
 </li>
 <li>
 Escalates patient care concerns or changing status until resolution is achieved
 
 
 
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 </ul>
 
 Coordination of care
 
 
 
 <ul>
 <li>
 Initiates appropriate referrals to the healthcare team based on assessed patient needs
 </li>
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 Communicates with the patient/family, interprofessional team, and community-based resources for safe transitions in continuity of care
 </li>
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 Ensures continuity of care by communicating effectively with patients, families, and healthcare providers
 </li>
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 Acts as a liaison between specialties and sub-specialties, coordinating referrals and follow-up appointments as needed to support the patient continuity of care between inpatient and outpatient care
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 Performs phone triage, manages prescription renewals, and coordinates follow-up appointments and care plans tailored to patients&rsquo; needs if working in an ambulatory setting
 
 
 
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 </ul>
 
 Health teaching and health promotion
 
 
 
 <ul>
 <li>
 Identifies barriers to learning, develops and implements education plan based on assessed patient/family needs
 </li>
 <li>
 that reflects the patient/family values, beliefs, developmental level, learning needs, readiness and ability to learn, language preference, spirituality, culture and socioeconomic status
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 Uses health promotion and teaching methods, including technologies to communicate health promotion and disease prevention
 
 
 
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 </ul>
 
 Evaluation
 
 
 
 <ul>
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 Evaluates and reports pertinent patient response to interventions based on evidence-based best practice
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 Evaluates progress toward attainment of expected outcomes and revises plan as necessary
 
 
 
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 </ul>
 
 Standards of professional performance ethics
 
 
 
 <ul>
 <li>
 Integrates code of Ethics for Nurses to guide practice and decision-making in all areas of practice
 
 
 
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 </ul>
 
 Advocacy
 
 
 
 <ul>
 <li>
 Functions as an advocate, seeking direction as needed to provide safe, effective, efficient, and timely care
 </li>
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 Demonstrates a willingness to address persistent, pervasive systemic issues
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 Embraces diversity, equity, inclusivity, health promotion for individuals of diverse geographic, cultural, ethnic, racial, gender, and spiritual backgrounds across the life span
 
 
 
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 </ul>
 
 Respectful and equitable practice
 
 
 
 <ul>
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 Establishes and maintains a therapeutic relationship with patient/family to ensure patient comfort and dignity without bias
 
 
 
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 </ul>
 
 Communication
 
 
 
 <ul>
 <li>
 Uses clear, closed loop communication that enhances team information sharing and decision making. Uses language translation resources to ensure effective communication
 </li>
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 Documents according to policy or guidelines in a timely and accurate manner in the medical record to communicate with the healthcare team
 
 
 
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 </ul>
 
 Collaboration
 
 
 
 <ul>
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 Supports goals through participation and compliance in unit activities, shared governance and decision-making
 
 
 
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 </ul>
 
 Leadership
 
 
 
 <ul>
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 Identifies conflict and helps to initiate resolution, seeking assistance when appropriate
 </li>
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 Demonstrates authority, ownership, accountability and responsibility for appropriate delegation of nursing care to unlicensed assistive personnel
 </li>
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 Assists by assuming a lead role as needs or schedule variances arise
 </li>
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 Assumes charge nurse role by completing additional training and competency to support the unit as requested
 
 
 
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 </ul>
 
 Education
 
 
 
 <ul>
 <li>
 Seeks experiences that reflect current practice to maintain and advance knowledge, skills, abilities, and judgment in clinical practice or role performance
 </li>
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 Mentors and/or trains new nurses to their roles for the purpose of ensuring successful enculturation, orientation, competence and emotional support
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 Supports the acculturation of nurses new to their roles by role modeling, encouraging, advocating, and sharing pertinent information relative to optimal care delivery
 
 
 
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 </ul>
 
 Scholarly inquiry
 
 
 
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 Participates in clinical research by following specific protocols
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 Uses current evidence-based knowledge, combined with clinical expertise to guide practice
 
 
 
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 </ul>
 
 Quality of practice
 
 
 
 <ul>
 <li>
 Complies with and supports regulatory and organizational policies and professional standards
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 Participates in Quality Improvement
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 Identifies trends in patient care outcomes for QI monitoring, practice change, and/or staff education
 
 
 
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 </ul>
 
 Professional practice evaluation
 
 
 
 <ul>
 <li>
 Participates in improving patient care by engaging in reviewing and supporting practice change based on evidence-based practice
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 Completes required ongoing development and education/competency/certifications as required
 
 
 
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 </ul>
 
 Resource stewardship
 
 
 
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 Ensures the correct functioning of equipment, identifies deficits and reports appropriately
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 Integrates connected health technologies into practice to promote positive interactions between patients and care providers
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 Submits required tasks and documentation to support chargeable and billable care activities
 
 
 
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 </ul>
 
 Environmental health
 
 
 
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 Creates a safe and healthy workplace and professional practice environment void of abusive, destructive or oppressive behaviors
 
 
 
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 </ul>
 
 Staffing to Demand &amp; Floating
 
 
 
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 Demonstrates flexibility in staffing, scheduling and traveling as needed to meet unit and the hospital system staffing needs for the greater good
 </li>
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 Willing to float between various care areas, departments, subspecialty clinics or ambulatory clinics as directed by supervisor and according to scope and competency
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 Nurses may be floated, flexed off or to stand-by according to policy based on schedule, volume and patient care needs and/or work activity demands to optimize resource allocation and maintain quality of care
 </li>
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 Supports staffing needs as deemed necessary by each individual Department or Service line. May be required to work alternating shifts or flexible hours including days, nights, weekends, or take on-call and/or call-back shifts to support regular and surge volume needs. These staffing changes will fluctuate with patient volume, acuity and staffing matrices
 
 
 
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 </ul>
 
 Travel Requirements
 
 
 
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 May be required to travel to satellite locations to support clinical practice care services as needed to ensure patient access and continuity of care.
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 Clinic nursing staff are required to travel to satellite outpatient clinics as needed to ensure patient access and continuity of care. Supports the coordination of patient care and services at these sites
 
 
 
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 </ul>
 
 License, Education And/or Experience
 
 
 
 <ul>
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 BSN preferred.
 </li>
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 Current RN license in the State of Texas.
 
 
 
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 </ul>
 
 Certificates, Registrations.
 
 
 
 <ul>
 <li>
 American Heart Association Basic Life Support (CPR) continuously maintained. May onboard with AHA or Red Cross CPR and then transition to AHA upon first renewal.
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 Advanced Specialty Courses (ASC) according to Attachment A
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 ASC courses should be taken at earliest opportunity, but must be completed within timeframes specified on Attachment A and continuously maintained ongoing.
 </li>
 </ul>
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 National Certification in specialty must be attempted within 4 years of hire date for eligible role and continuously maintained thereafter.
 </li>
 </ul>
</div>

Outpatient RN

<div><h1 class="jobSectionHeader">Where compassion meets innovation and technology and our employees are family.
</h1><div>Thank you for your interest in joining our team! Please review the job information below.
</div>G ENERAL P URPOSE OF J OB : 
 
The Claims and Appeals Specialist II is a certified medical coder that performs audits for correct coding and claims payments and oversees the claims appeal process for provider and member appeals. This position also investigates Coordination of Benefit (COB) claims. The Claims and Appeals Specialist II reports to the Director of Claims Oversight. 
 
E SSENTIAL D UTIES AND R ESPONSIBILITIES : 
 
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive;
 
employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.
General Duties:
<ul><li>Maintains the utmost level of confidentiality at all times.
</li><li>Adheres to hospital and DHP policies and procedures.
</li><li>Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
</li><li>Performs other duties as requested.
</li><li>Claims and Appeals Specialist II Duties and Responsibilities:
</li><li>Reviews claims appeal and makes recommendations regarding reprocessing/denial of payment.
</li><li>Research provider&rsquo;s claims questions.
</li><li>Works closely with Provider Relations Representatives to assist with provider claim issues.
</li><li>Provides incite to potential claims payment issues.
</li><li>Notifies Compliance Officer for DHP of potential fraud and abuse.
</li><li>Research billing issues.
</li><li>Responds to providers regarding claims-related issues.
</li><li>coordination of benefit activities.
</li><li>Coordinates re-consideration of claims with DHP&rsquo;s Third Party Claims Administrator
</li><li>Active member of bi-weekly claims meetings between DHP and DHP&rsquo;s Third Party Claims Administrator.
</li></ul>E DUCATION AND / OR E XPERIENCE :
High school diploma or general education degree (GED); or associate&rsquo;s degree (A. A.) or equivalent from two-year college or technical school; three to five years related experience and/or training; or equivalent combination of education and experience.
 
3 -5 years&rsquo; experience of coding in an acute care hospital setting preferred</div>

Claims & Appeals Specialist II

<div>
 
 
 Where compassion meets innovation and technology and our employees are family.
 
 
 
 
 
 Thank you for your interest in joining our team! Please review the job information below.
 
 
 
 
 General Purpose of Job:
 
 
 
 The STAR Kids Transition Coordinator understands that the transition to adulthood is one of the most significant events in an individual&rsquo;s life, especially for individuals with disabilities receiving publicly funded services under a children&rsquo;s program. Federal and state public policies use different sets of eligibility criteria, new program service arrays, and limitations on nursing/attendant hours for adult programs which may offer less intensive services than children&rsquo;s programs. Preparing for adult transition requires significant early planning led by a transition coordinator who assembles a transition team and develops a transition plan with an extensive array of activities to maximize independence and assist the youth in qualifying for the appropriate adult programs. The
 
 
 STAR Kids Transition Coordinator will oversee and lead all transition activities from initial contact through final transition to STAR+PLUS, other HHSC programs or other community-based programs. The STAR Kids Transition Coordinator is committed to ensuring that all members live in the most integrated residential setting of their choice.
 
 
 In addition, the STAR Kids Transition Coordinator will work with the nursing facility or intermediate care facility to relocate the member back to the community setting of their choice.
 
 
 
 Essential Duties and Responsibilities:
 
 
 
 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by Health Plan leadership, as required
 
 
 
 Knowledge, Skills and Abilities:
 
 
 
 <ul>
 <li>
 Knowledge in Texas Medicaid criteria/guidelines preferred.
 </li>
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 Knowledge about managed care contracts/guidelines preferred.
 </li>
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 Knowledge of programs and services required to support the health and medical needs of disabled children preferred.
 </li>
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 Knowledge of various reimbursement mechanisms, including third party requirements preferred.
 </li>
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 Microsoft Office skills preferred.
 </li>
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 Maintains utmost level of confidentiality at all times.
 </li>
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 Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC.
 </li>
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 Implements and adheres to Health System and Health Plan policies and procedures for members with special health care needs (STAR Kids).
 </li>
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 Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.
 
 
 
 </li>
 </ul>
 
 Responsibilities:
 
 
 
 <ul>
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 Function in an advisory role to the Medical Directors and Medical Management Committee in the following areas:
 </li>
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 Provide evaluation of and assist in the development of quality patient care
 
 
 
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 </ul>
 services offered by DCHP;
 
 
 <ul>
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 Assist in the establishment of patient care and professional staff policies and
 
 
 
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 </ul>
 procedures of DCHP; and
 
 
 <ul>
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 Participate in long-range planning of services and/or programs offered by DCHP.
 </li>
 <li>
 This position shall be responsible for the following aspects of the program:
 </li>
 <li>
 Assemble a transition team and develop a transition plan with an extensive array of activities to maximize independence and assist the youth in qualifying for the appropriate adult programs for those members who will be aging out of STAR Kids.
 </li>
 <li>
 Develop policies, informational material, resource guides, transition assessment, transition readiness, planning/integration into adult services, and transference and admissions support to adult services.
 </li>
 <li>
 Oversee and lead all transition activities from initial contact through final
 
 
 
 </li>
 </ul>
 transition to STAR+PLUS or other community-based programs.
 
 
 <ul>
 <li>
 Be knowledgeable about children&rsquo;s issues, transition activities, local community resources, Medicaid eligibility, guardianship issues, and working with individuals with complex needs and their families, STAR+PLUS, programs administered by the Department of Aging and Disability Services (DADS), TEA, Department of Assistive and Rehabilitation Services (DARS) and all other relevant state agencies and community-based organizations.
 </li>
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 Conduct a transition assessment that results in a continuity of care plan and
 
 
 
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 </ul>
 checklist that captures all the youth&rsquo;s needs and all necessary and relevant
 
 
 activities are met with no breaks in service or medication availability.
 
 
 <ul>
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 Identify adult healthcare providers and assist in transitioning member to new
 
 
 
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 </ul>
 provider.
 
 
 <ul>
 <li>
 Work with a nursing facility (NF) or intermediate care facility (ICF) to establish a permanency plan to relocate the Member back to the community setting of their choice.
 </li>
 <li>
 Establish communication links with appropriate staff/permanency planners, an effective monitoring schedule, establishing written service plan for safe relocation, and identifying appropriate short-term intensive services/supports for post-relocation community placement to help ensure stabilization.
 </li>
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 Conduct other appropriate assessments according to STAR Kids contract.
 </li>
 <li>
 Must be knowledgeable about managed care Medicare/Medicaid
 
 
 
 </li>
 </ul>
 criteria/guidelines
 
 
 <ul>
 <li>
 Must have a working knowledge of various reimbursement mechanisms including third party requirements and Medicare
 </li>
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 Negotiates with vendors when necessary for services/equipment
 </li>
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 Ensure appropriate referrals to agencies and assistance programs are completed
 </li>
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 Complete documentation about a member&rsquo;s plan of care, progress toward meeting care goals, outcomes, case reports, etc.
 </li>
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 Produce status reports on a regular basis to track members in STAR Kids
 </li>
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 Participates in health plan&rsquo;s performance improvement activities
 </li>
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 Participates in health plan committees as appropriate and on request
 </li>
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 Communicates with management regarding status of current workload and turn-around time discrepancies as necessary. Must obtain approval from manager or designee to any redistribution of workload.
 </li>
 <li>
 Ensure thorough knowledge of the STAR Kids contract and meet all Service
 
 
 
 </li>
 </ul>
 Coordination contract requirements.
 
 
 <ul>
 <li>
 This position shall also be responsible to perform other such professional services as may be requested by DCHP from time to time.
 
 
 
 </li>
 </ul>
 
 Education and/or Experience:
 
 
 
 <ul>
 <li>
 Bachelor's degree from four-year college or university; or equivalent combination of education and experience preferred
 </li>
 <li>
 Minimum 3 years&rsquo; transition or community resource experience (pediatric preferred) or 1 year experience in managed care or case management
 </li>
 <li>
 Previous experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and disabled children preferred.
 </li>
 <li>
 Knowledge of Medicaid/Medicare preferred
 
 
 
 </li>
 </ul>
 
 Certification, Registration or Licensure:
 
 
 
 <ul>
 <li>
 Current driver&rsquo;s license and insurance
 </li>
 </ul>
</div>

Transition Coordinator

<div>
 
 
 Where compassion meets innovation and technology and our employees are family.
 
 
 
 
 
 Thank you for your interest in joining our team! Please review the job information below.
 
 
 
 
 General Purpose of Job:
 
 
 
 To assist health care providers and clerical staff in the ambulatory patient care areas. Provides developmentally appropriate care for the ages of patients served. Perform a variety of routine and specialized tasks. Specific job duties include Performs and documents vital signs and physical measurements in an age-appropriate manner. Performs phlebotomy procedures, performs ancillary testing, promotes safety and infection control, calls pharmacy to authorize medication refills as per physician&rsquo;s orders, performs clerical duties to include answering telephones, greeting patients, appointment scheduling, insurance pre- authorizations, chart preparation and completion, retrieves diagnostic reports and dictations, arranges for hospital admissions, and procedures, and reinforces physician discharge orders.
 
 
 
 Essential Duties and Behavioral Expectations:
 
 
 
 To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
 
 
 <ul>
 <li>
 Maintains utmost level of confidentiality at all times.
 </li>
 <li>
 Adheres to hospital policies and procedures.
 </li>
 <li>
 Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
 </li>
 <li>
 Schedules appointments, receives money for bills, keeps x-ray and other medical records, performs secretarial tasks, and completes insurance forms.
 </li>
 <li>
 Keys data into computer to maintain office and patient records.
 </li>
 <li>
 Performs and documents vital signs and physical measurements in an age-appropriate manner
 </li>
 <li>
 Prepares patient for examination.
 </li>
 <li>
 Performs and documents vital signs according to hospital standards.
 </li>
 <li>
 Identifies abnormal vital signs and reports to the nurse or MD.
 </li>
 <li>
 Measures height and weight accurately.
 </li>
 <li>
 Documents or photocopies current immunization accurately.
 </li>
 <li>
 Documents allergy status accurately.
 </li>
 <li>
 Assists with the preparation of equipment. and aids physician during treatment, examination, and testing.
 </li>
 <li>
 Performs waive testing procedures such as glucose monitoring, urine dipstick, rapid-strep, hemoccult and urine pregnancy test.
 </li>
 <li>
 Passes competency validations annually.
 </li>
 <li>
 Labels appropriately, all waive testing controls with date opened, and expiration date.
 </li>
 <li>
 Maintains QC monitoring as appropriate.
 </li>
 <li>
 Documents legible and accurately
 
 
 
 </li>
 </ul>
 
 Performs general lab duties as assigned
 
 
 
 <ul>
 <li>
 Performs venipuncture, finger stick, and heel stick phlebotomy procedures as per hospital policy.
 </li>
 <li>
 Processes lab specimens, performs tests, and reports results as written in applicable policies and procedures.
 </li>
 <li>
 Performs only those tests that are authorized by the licensed professional and require a degree of skill commensurate with the individual&rsquo;s education, training or experience, and technical abilities.
 </li>
 <li>
 Maintains records that demonstrate that proficiency-testing samples are tested in the same manner as patient samples.
 </li>
 <li>
 Adheres to laboratory quality control policies, documents all control activities.
 </li>
 <li>
 Identifies problems that may adversely affect test performance or reporting of test results and either must correct problems immediately or notify nurse in charge.
 
 
 
 </li>
 </ul>
 
 Promote safety and infection control
 
 
 
 <ul>
 <li>
 Observes and enforces guidelines for infection control in administering care, demonstrating adherence to infection control guidelines.
 </li>
 <li>
 Promotes safety of all patients and personnel.
 </li>
 <li>
 Promotes and ensures safe and effective use of equipment in assigned areas as observed annually by supervisory observation.
 </li>
 <li>
 Cleans toys per hospital policy.
 </li>
 <li>
 Responds to emergency situations as evidenced by ongoing supervisory observation.
 
 
 
 </li>
 </ul>
 
 Assists Nursing Personnel And Performs Other Duties
 
 
 
 <ul>
 <li>
 Collaborates with licensed nurse in ensuring that all nursing care required by patients is administered and documented.
 </li>
 <li>
 Stocks supplies and exam rooms daily.
 
 
 
 </li>
 </ul>
 
 Medication administration
 
 
 
 <ul>
 <li>
 Health teaching and counseling as ordered by medical provider.
 </li>
 <li>
 Administer prescribed medications and immunizations.
 
 
 
 </li>
 </ul>
 
 Maintains interaction and communication
 
 
 
 <ul>
 <li>
 Maintains unit, department, and hospital communication as observed by supervisor.
 </li>
 <li>
 Attend staff meetings or signs attendance records for reading of minutes and attends all mandatory in-services 100% of the time as evidenced by a review of minutes and Staff Development Records.
 </li>
 <li>
 Notifies licensed staff or supervisors when unable to complete assigned or tasks or responsibilities.
 </li>
 <li>
 Monitors patients flow in clinic and guest relations to promote customer service.
 
 
 
 </li>
 </ul>
 
 Education and/or Experience:
 
 
 
 <ul>
 <li>
 High school diploma or general education degree (GED)
 </li>
 <li>
 Completion of medical assistant training course accredited by the Bureau of Private Post secondary and Vocational Education in the Department of Consumer Affairs or CAAHEP.
 </li>
 <li>
 Prior experience as a certified medical assistant preferred
 </li>
 <li>
 Basic knowledge of computers
 </li>
 <li>
 Current BLS or within six months of hire
 </li>
 <li>
 Attempt National Certification or Registry as Medical Assistant (CMA or RMA) within two years of hire
 </li>
 </ul>
</div>

Medical Assistant

Join Driscoll Children's Hospital and explore 4   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Driscoll Children's Hospital

About Company

Outpatient RN

Claims & Appeals Specialist II

Transition Coordinator

Medical Assistant